Provider Demographics
NPI:1306193388
Name:CIPOLLA, MARK PAUL (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:PAUL
Last Name:CIPOLLA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DRIVE, MSC 7914
Mailing Address - Street 2:UT HEALTH SCIENCE CENTER AT SAN ANTONIO
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3900
Mailing Address - Country:US
Mailing Address - Phone:210-567-3456
Mailing Address - Fax:210-567-3443
Practice Address - Street 1:7703 FLOYD CURL DRIVE, MSC 7903
Practice Address - Street 2:UT HEALTH SCIENCE CENTER AT SAN ANTONIO, ADVANCED GENER
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3900
Practice Address - Country:US
Practice Address - Phone:210-567-3456
Practice Address - Fax:210-567-3443
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXETN88390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program